三明市医共体内外经济激励对医疗服务供给的影响研究

Research on the influence of internal and external economic incentives of Sanming county medical alliance on medical service supply

目的:了解三明市内部年薪工分制改革与外部医共体打包支付及其他一系列配套政策改革下医疗服务供给的变化情况,以及内外部经济激励政策的协同影响机制。方法:以三明市2015年8月年薪工分制改革、2018年1月医共体打包支付改革为政策干预时点,采用间断时间序列(ITSA)分段回归模型对3个政策时段月度数据的变化情况进行分析。结果:年薪工分制实施后,全市及基层门急诊人次均较改革前有大幅提升,医院门急诊人次仍保持既往上涨趋势。医共体打包支付实施后,全市、基层、医院门急诊及入院人次的上升趋势均明显减缓,基层门急诊人次占比增长速度明显下降。结论:发挥外部经济激励的宏观调控作用,能够规范由不合理内部经济激励引起的过度医疗服务供给行为;内部与外部经济激励联动改革,才能顺利推进分级诊疗制度的实施。

Objective: To explore the changes of medical service supply in Sanming under the internal annual salary point system reform, the external county medical alliance package payment reform and a series of other supporting policies, and the synergistic influence mechanism of internal and external economic incentive policies.Methods: Taking Sanming’s annual salary point system reform in August 2015, and the package payment reform of county medical alliance in January 2018 as the policy intervention points.The monthly data changes in the three policy periods were analyzed by using the interrupted time series(ITSA) regression model.Results: After the implementation of the annual salary point system, the outpatient and emergency visits of the whole city and grassroots hospitals were significantly increased, and the outpatient and emergency visits of the hospital still kept the upward trend.After the implementation of package payment reform of county medical alliance, the upward trend of outpatient and emergency visits and inpatients in the whole city, grassroots hospitals and hospitals slowed down significantly, and the growth rate of the proportion of outpatient and emergency visits in grassroots hospitals declined significantly.Conclusion: Exerting the macro-control function of external economic incentives can regulate the behavior of excessive medical service supply caused by unreasonable internal economic incentives.Only coordinated reform with internal and external economic incentives can smoothly promote the implementation of hierarchical medical system.